Medical Examiner

Mayor Pete Is Not an Anti-Vaxxer

His answer to the BuzzFeed question on vaccine exemptions wasn’t that unreasonable.

Pete Buttigieg holds tented fingers up to his face.
Pete Buttigieg in Harlem, New York, on Monday.
Bebeto Matthews/AFP/Getty Images

Pete Buttigieg is said to have made a huge mistake this week when he “badly fumbled” a reporter’s question on vaccine policy. For a piece published Tuesday evening, BuzzFeed News sought answers from each 2020 presidential candidate on the following measles outbreak–related questions: What does each candidate believe about vaccines, what do they believe about a supposed link between vaccines and autism, and would they support an end to religious and personal belief exemptions when it comes to vaccination mandates? Buttigieg’s campaign issued the following response, according to BuzzFeed:

The law of the land for more than a century has been that states may enforce mandatory vaccination for public safety to prevent the spread of a dangerous disease. Pete does support some exceptions, except during a public health emergency to prevent an outbreak. These exemptions include medical exemptions in all cases (as in cases where it is unsafe for the individual to get vaccinated), and personal/religious exemptions if states can maintain local herd immunity and there is no public health crisis.

Umm, that’s not how vaccination works, replied the People of the Internet. Is science not one of the 29 languages that you speak? Because your proposal is ill-informed, misguided, and impossible to enforce in real time. “This is super disappointing,” tweeted physician and New York Times writer Jennifer Gunter. “Essentially a disqualifier for me.”

The backlash was so strong that Buttigieg’s campaign walked back the statement several hours later. Shortly after midnight early Wednesday morning, BuzzFeed’s Claudia Koerner reported the following addendum: “[Buttigieg] is aware that in most states the law provides for some kinds of exemptions,” his campaign had told her. “He believes only medical exemptions should be allowed.”

Now that everyone is safe and sound and vaccines have been paid their due respect, perhaps we ought to take a closer look at Buttigieg’s Big Mistake. Just how superdisappointing was his statement, really?

Call me ill-informed, misguided, or even impossible to enforce, but I don’t believe the mayor really flubbed this answer. Buttigieg’s main mistake, I guess, was to say (before recanting) that he supports the provision of religious and personal exemptions to statewide vaccination rules for putting kids in school. That’s not really so outlandish. Just three state legislatures (California, Mississippi, and West Virginia) have banned the use of both religious and personal exemptions, while roughly half a dozen more have lately floated plans to do the same. If you’re living in any of the other four-fifths of the country, though, you may at the very least refuse vaccines for your children on the basis of “sincere and genuine religious beliefs,” now and presumably into the foreseeable future. It’s neither particularly ill-informed nor surprising for Buttigieg, or any other candidate for national office, to endorse this standard compromise between public health and people’s freedom of religion.

It’s true the other kind of exemptions—the ones taken not for religious reasons but rather on the basis of someone’s personal (or “philosophical”) beliefs—are far more controversial. These are allowed in just 17 states, though they’re often cited as a contributor to the recent growth and spread of measles outbreaks. That link is far from clear: The majority of this year’s cases have occurred in New York state, which allows religious but not personal exemptions. And while the anti-vaxxer movement, as a whole, is often characterized in press reports as “a serious and growing public health time bomb,” there isn’t strong evidence for the claim that the use of personal exemptions has been blowing up. Even though one-third of the U.S. currently allows personal exemptions, the nation’s overall measles vaccination rate has remained pretty high and very stable for the past quarter-century, at 91 or 92 percent. One recent study found that the overall use of personal exemptions had been increasingly slowly for a time but that it has lately leveled off. As I noted back in February, there does not appear to be a strong correlation between the presence or absence of personal exemptions to a given state’s vaccination laws and that same state’s overall MMR vaccine coverage.

Still, you might prefer—and I might prefer—that Buttigieg had come out against personal exemptions from the get-go, on the presumptive theory that they provide the legal loopholes most easily abused by anti-vaxxers. (Let’s ignore the fact that Mayor Pete, even if he were elected president, would have no sway over any of these local regulations.) Some may wish that Buttigieg had also originally argued that Americans’ near-ubiquitous right to claim religious exemptions from vaccination laws should be stripped away as well. It’s still bizarre that so many framed Buttigieg’s original, uncorrected take on vaccinations—that both religious and personal exemptions might be permitted as a rule, and then revoked in case of an emergency—as outlandish, anti-science, or absurd. On the contrary, it’s not so crazy to suggest that vaccination regulations (whatever they may be) could be tightened, on the fly, in response to sudden, local outbreaks of disease. That’s more or less how the laws are presently administered!

Take New York City, where the bulk of this year’s measles cases are turning up among Orthodox Jews. According to statistics cited by Politico, 99 percent of the city’s public-school students have been vaccinated, while just 0.25 percent have demurred on religious grounds. Most Orthodox Jewish schools have similarly high coverage rates, though there are specific pockets of anti-vaxxer sentiment and behavior among the Orthodox Jews in Williamsburg, Brooklyn. It’s this vulnerable neighborhood, in particular, that has been at the center of the present crisis.

That’s why the city’s mayor, Bill de Blasio, in declaring a state of emergency last month, made vaccination compulsory for all children and adults in four ZIP codes in Williamsburg. Isn’t this just a version of the Buttigieg plan? A measles crisis had struck a local area with insufficient herd immunity, so Mayor Bill pulled a Mayor Pete: He overrode the religious exemptions and prescribed vaccines for everyone.

Responses to Buttigieg didn’t just suggest the mayor was epidemiologically illiterate. His online critics also claimed that he’d given his bad answer in hopes of pandering for votes. By pledging his support for exemptions, he’d offered up a sop to Goop subscribers and the anti-vaxxer crowd; by saying there were times when exemptions ought to be suspended, he’d tried to please the science lovers, too.

If this were true, it would indeed show a remarkable lack of judgment from the Buttigieg campaign. Why would any politician bother pandering to such a tiny and reviled group as anti-vaxxers? Compulsory vaccination for public schoolchildren is remarkably popular, with 82 percent of Americans supporting it. I guess it’s possible that Buttigieg himself was led astray by all the puffy coverage of the anti-vaxxer menace, which often makes the movement sound more influential (and worth more votes) than it really is.

There’s another, better explanation for what happened, though. If Buttigieg erred in his original answer, it’s probably because, unlike his rivals for the Democratic nomination, he neither pandered to his party’s most agitated, anti-anti-vaxxer voting bloc, nor did he dodge the question. Here’s how the other 17 candidates responded—or failed to respond—to the BuzzFeed questions: Eight of them, including Joe Biden, Elizabeth Warren, Beto O’Rourke, and Amy Klobuchar, chose not to answer when first approached. Later, after the Buttigieg flub blew up on social media, Warren chimed in to say she thinks personal and religious exemptions should in fact be banned. O’Rourke also gave some answers after the fact (but even then did not address vaccine exemptions).

Cory Booker took a stand against both personal and religious exemptions from the start. A spokesperson for Kamala Harris told BuzzFeed simply: “She thinks people should get vaccines.” Bernie Sanders gave a pretty sketchy answer—“Any exemptions should be rare and consistent with public health needs,” his spokesperson said—which is not on its face in conflict with Buttigieg’s original, “badly fumbled” answer.

Half of the Democratic candidates—including four of the six now leading the polls—refused to take any position on vaccine exemptions. Among the nine candidates who did, only one—Jay Inslee—suggested that personal exemptions might be eliminated while religious exemptions were preserved. That leaves eight candidates, including post-recanting Buttigieg, who have called for the elimination of both the controversial personal exemptions and the standard religious ones that are now permitted in 47 U.S. states.

If Buttigieg got his answer to the BuzzFeed question wrong, it’s only because he didn’t understand the test. No one was looking to hear a politician’s callback to the legal precedent for mandatory vaccination or the details of his views on which exemptions to the rules should be allowed and when. This was not a forum for debate on liberty and public health, or the science of contagion. It was a chance for candidates to take a stand: Are you with us or against us? Are you pro-vaccine, or will you be campaigning on the side of measles, rubella, and Ebola?

At least he gets it now, having faced the backlash and reversed his stated views. When someone starts by asking, “Do you believe in vaccines?,” your plan of action should be clear: Say yes and nothing more.